The present invention relates to the harvesting of blood vessels and, more particularly, to a method and apparatus for dissection and removal of sections of blood vessels.
The harvested vessels are used in many surgical procedures, including use as a coronary artery bypass graft, or in other cardiovascular procedures. As one example, in vascular and cardiovascular procedures, a blood vessel or vessel section, such as an artery or vein, is “harvested” (i.e., removed) from its natural location in a patient's body and is used elsewhere in the body. In coronary artery bypass grafting surgery, for example, the harvested blood vessel is used to form a bypass between an arterial blood source and the coronary artery that is to be bypassed. Among the preferred sources for the vessels to be used as the bypass graft are the saphenous vein in the leg and the radial artery in the arm.
In the past, the harvesting was done through a continuous incision (e.g., along the leg) that exposed the full length of the desired vein section. The continuous incision had been necessary in order to provide adequate exposure for visualizing the vein and for introducing the surgical instruments to sever, cauterize and ligate the tissue and side branches of the vessel.
A more recent development has been a minimally-invasive technique that employs a small incision for locating the desired vessel and for introducing one or more endoscopic devices into the small incision. Commercially available endoscopic products for performing the blood vessel harvesting procedure include a number of separate devices that are used for each stage of the dissecting and harvesting of the vessel. These separate endoscopic devices, are in turn, connected to remote or outside pieces of equipment that are used to control the endoscopic devices. In many instances, an endoscope having a camera and light cable is used in order to visualize both the dissection and harvesting procedures. Also, the harvester devices and/or dissector devices have electrical or other lines attached in order to supply the dissecting and/or cauterizing of the vessel.
The harvesting of blood vessels also includes the use of insufflators in order to create an open area around the vessel being dissected and harvested. The insufflators are attached to supplies of air or CO2 that are connected to external sources in the operating room. The currently available insufflators are typically intended for use in general and gynecological endoscopic surgeries, and have historically performed safely when used as intended. Such insufflators are commonly utilized in both day surgery and hospital operating rooms. Many types of endoscopic surgical procedures that include the use of insufflators typically require several liters of CO2 to inflate and maintain the area surrounding the surgical site. As such, the currently marketed insufflators typically have pressure/flow rates ranging from about 0.1 liters/min to about 20.0± liters/min. These insufflators are particularly designed to deliver CO2 into the endoscopic surgical field at high flow rates ranging between about 8-20 liters/min.
In certain instances, however, there may be a concern that excessive gas (e.g., CO2) pressure and/or flow rates may be introduced into the subcutaneous area during an endoscopic vessel dissection/harvesting procedure. The clinician is particularly careful to prevent or reduce any risk that the vessel harvesting procedure could induce a gas embolism(s). This is a concern since the clinician is often not able to quickly and independently set or adjust the pressure rates and/or flow rates. This becomes a concern since the clinician is within the sterile field while any means for adjusting the insufflators is remote from the sterile field. Typically, the insufflator flow rate settings are controlled from outside the sterile field by a circulating assistant who must then respond to verbal directions from the clinician, rather than by the clinician located within the sterile field.
There is a particular concern when the endoscopic procedure is an endoscopic vessel harvesting procedure since such procedures require much lower CO2 pressure rates and/or flow rates than general and gynecological endoscopy procedures, as noted above. These lower flow rates, which typically range between 0.5 liters/min to 5.0 liters/min, are needed in order to achieve and maintain the precise inflation of the subcutaneous areas that are needed during the vessel dissection and harvesting.
It would be desirable to have an insufflator device that provides a rapid and easily accessible system for adjusting the insufflation gases being used in endoscopic procedures.